COVID-19
Therapies Not Routinely Recommended

Therapies Not Routinely Recommended

Agent

Based on multiple cardiology and nephrology societies’ review, it is not recommended to routinely discontinue ACEi/ARB therapy to decrease risk for more severe COVID-19 disease

  • Continue if previously prescribed.
  • Insufficient data to support initiating. 
  • Small studies suggest benefit in hospital outcomes.

Not recommended in the absence of bacterial infection.

Initiating and continuing empiric antibiotics may lead to adverse events, antibiotic resistance

Not recommended. No improvement in mortality compared to usual care (RECOVERY)

While early small trials may have showed activity of the drug against SARS-CoV-2⁽⁴⁾⁽⁸⁾, recent data indicates a high number of cardiac complications that have resulted in deaths.

No in vitro or clinical data yet exist to support this use, though a clinical trial has been registered in China

Not routinely recommended for treatment of COVID-19 in ambulatory patients. It may be used on a case-by-case basis for patients with risk factors for severe disease using shared decision making weighing the risks and benefits.

Limited evidence of effectiveness of hydroxychloroquine in treatment of Covid-19 patients, and a recent study showed an association of increased overall mortality was identified in patients treated with hydroxychloroquine alone, highlighting importance of waiting for results of prospective, randomized, controlled studies before widespread use.

There is little rationale for this use since available IVIG products are unlikely to contain specific antibodies to SARS-CoV-2, given lack of widespread immunity.

IVIG has been suggested to have anti- inflammatory or immunomodulatory effects; however, given the lack of conclusive clinical data for treatment of novel coronaviruses and national shortage of IVIG products, routine use of IVIG is not recommended at this time

  • Typically used in combination with ribavirin, interferons have been studied for patients with other coronaviruses, with mixed results

  • Their adverse effect profiles are also generally unfavorable

Insufficient data to recommend for or against the use of ivermectin in COVID

  • Recent study showing lack of benefit in severe cases

  • Side effects can be moderate/severe are often treatment limiting

  • In vitro studies suggesting activity, but clinical reports inconclusive to negative

  • Limited supply, many drug interactions

  • Some in vitro studies have demonstrated potency against SARS-CoV- 2, though clinical use against other coronaviruses has not demonstrated benefit

  • Poorly tolerated formulation; safety profile is relatively benign

  • No evidence exists to support its use in mitigating the inflammatory response associated with COVID-19

  • There are reports of NSAID use preceding clinical deterioration in some patients with severe COVID- 19 disease, however data is very limited

  • APAP preferred first line, however NSAIDs could be considered second line

  • Coronaviruses do not utilize neuraminidase for the budding stage of reproduction and therefore no activity is expected

  • If influenza is unknown or positive, oseltamivir should be started

  • Stop if flu A/B PCR negative AND low suspicion

Typically used in combination with an interferon, ribavirin has been studied for patients with other coronaviruses, with mixed results. Additionally, its adverse effect profile can be significant (anemia), particularly at the dosages for which it has been tested for MERS (~800-3600mg/day)

  • Insufficient data to support routine use.  
  • Supplemental doses have low risk for harm
  • Insufficient data to support routine use. 
  • Supplemental doses have low risk for harm